The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding Medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

(sigh) OK, with three states still missing, you just knew I wouldn't rest until I was able to fill in the missing pieces of the puzzle. Sometime today, the HHS Dept. finally entered the approved rate hikes for individual makret carriers in two of those states: New Hampshire and Virginia. Louisiana is still AWOL for whatever reason.

It's important to note that sometimes the "Final Rate Increase" percentages listed at RateReview.HealthCare.Gov dont' actually end up matching the approved rate hikes found in the official SERFF databases or even at the state's Dept. of Insurance website. Normally I cross-check all three to make sure nothing weird is going on, but given that it's well past time to move on, I'm relying purely on the RateReview numbers for these states.

I assumed a similar pattern to last year, with roughly 15% net attrition as of the end of June, which would have resulted in roughly 10.8 million people having effectuated exchange policies as of 6/30/16. Instead, they say it was around 10.5 million. Based on this new data, I'm revising my net attrition estimates for the rest of the year to perhaps 9.8 million as of the end of September. If so, this would result in ending 2016 with around 9.2 million people enrolled in effectuated exchange policies, for a 2nd-half monthly average of around 9.9 million and a full-year monthly average of around 10.1 million.

The main focus of this Late Night with Seth Meyers segment is about how Donald Trump completely whiffed on what should have been a reasonably strong attack on Hillary Clinton: Namely, the 25% average unsubsidized individual market rate hikes which are coming next year.

In the process, however, Meyers actually did a fairly good job of summarizing the situation:

"Now, that's bad news on the surface...but it's still in line with the projections made by the Congressional Budget Office. Obviously, Obamacare is a nuanced, complicated issue that requires sober analysis and discussion...or, as Donald Trump put it..."

NOTE 10/29/16: For anyone who read this entry yesterday, please note that I've gone back and completely reworked all 4 the charts, along with adding a fifth one, for several reasons:

I had to correct an error re. Medicaid expansion (I had Iowa not expanded and Wisconsin expanded by mistake)

I was able to add the final approved averages for both New Hampshire and Virginia, leaving Louisiana as the only state with a "requested" average only

The original graphs only listed the median rate hikes for each group; they now list the actual weightedaverages for each group of states

I even added a fifth chart which separates the states out into those which embraced all 3 provisions vs. those which only embraced 1 or 2 of them, and those which didn't implement any.

OK. I ran the numbers several different ways way back in August, when I had compiled the requested 2017 individual market rate hike averages for all 50 states (+DC). However, many things have changed since then. Not only do I have the approved rate changes for 48 states, there were a lot of other major changes along the way, including various carrier pullouts and rate filing re-submissions.

As noted before, I'm really trying to move onto the actual enrollment part of the 2017 open enrollment period, but I can't resist doing some more final cleanup of my Rate Hike project:

SOUTH CAROLINA: This is one of the 5 states which I still didn't have approved rate changes for. Today the RateReview.HC.gov site finally added in the final numbers for SC, so here's what it looks like:

Aetna was a bit tricky--the total enrollee number is actually 41,988. They dropped out of the ACA exchange but are sticking around the off-exchange market, so I had to figure out how many of those 42K are on vs. off-exchange. The answer is in this article which notes:

More than 220,000 South Carolinians rely on the federal health care law for insurance. This year, only 8,000 of them are covered by Aetna plans.

Going into the fourth year of open enrollment, my work here at ACA Signups has started to fall into a seasonal pattern. During open enrollment itself, of course, it's all about the core mission of the site: Live-tracking the number of people who actually sign up for ACA exchange policies, and the related news items which accompany that. In the spring, it's all about dust settling and wrapping up: Plugging in the hard numbers, seeing how they compare with what I had projected and so on.

In the summer and fall, however, I'm on my second year of tracking the average (unsubsidized) rate increases people can expect for the following year.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

More Than 70 Percent of Consumers Can Find Marketplace Plans for Less than $75 Per Month

With Start of Window Shopping, Americans Can Now Check Out Options for 2017 Coverage

With window shopping beginning today, Health Insurance Marketplace consumers can now visit HealthCare.gov to check out their options for 2017 coverage in advance of the start of Open Enrollment on November 1. A new report released today shows that 72 percent of Marketplace consumers in states using HealthCare.gov will be able to find plans with a premium of less than $75 per month and 77 percent will be able to find plans with premiums below $100, taking into account financial assistance. The report also shows that consumers will have options, with an average of 30 health insurance plans to choose from.

Consumers can expect at least two big changes this fall when they go shopping for their 2016 health insurance through the Massachusetts Health Connector: significantly fewer choices, and a new mechanism to find out which care networks include their doctors.

The Connector staff told the agency’s governing board Thursday that the number of plans offered next year will be no more than 81, down from the current 126.

The board had agreed in March that the Connector needed to simplify its offerings. The differences among the plans were described as too small to justify the confusion caused by so many options.

(judging from the Mervyn's ad campaign, white middle-class suburban women were the only ones who bought clothing in the '90's....)

With Open Enrollment 2017 just 11 days away and the books closed on my Average Rate Hike project (don't worry, I'll fill in the remaining 10 states later but with 41 states accounted for, I think I've made my point), I figured it'd be a good point to take a look at which of the ACA exchange websites are already open for 2017 window shopping and which ones aren't:

Yesterday, Kaiser published a completely updated version of their analysis. In addition to having more recent data to work with (including the increased number of ACA exchange enrollees, the increased number of people covered by Medicaid thanks to ongoing ACA expansion progress, etc), they also made some changes in their methodology. The most obvious change is that their estimate of the total uninsured (non-elderly only; you'd have to bump the number up by perhaps 1 million more if seniors were included) has dropped from 32.3 million to 27.2 million nationally.

In addition, however, the proportion of people falling into different categories has shifted as well. Here's how they break it out:

OK, now that both HHS and I agree that the ACA exchange target for the 2017 Open Enrollment Period is around 13.8 million QHP selections, it's time to dust off The Graph and reset it for 2017.

It was fairly easy to do so this time because this is the first year that the starting and ending dates match (November 1st to January 31st). All I really had to do was bump up the 1/31/17 projection from 12.7 million to 13.8 million, and the rest of the projection line adjusted accordingly.

With that in mind, here's how I expect things to play out for Year 4 (click below for a higher-res version):

Unfortunately, due to an ongoing side project of mine, I haven't had a chance to write up a full analysis/projection for OE4 as I usually do around this time.

However, I've been informed that the HHS Dept. plans on issuing their 2017 Open Enrollment projections in the near future, so I'm throwing this out there quickly:

I expect somewhere between 13.5 - 14.0 million people are likely to select QHPs via the ACA exchanges during the 2017 Open Enrollment Period (which runs from 11/01/16 - 1/31/17).

As always, it's important to remember that QHP selections are not the same as effectuated policies...there's usually around 10% or so of enrollees who never bother paying their first premium and thus are never actually enrolled, and of course there's attrition after that as people drop their policies after 1, 2, 3 months or more for various reasons (many replaced by new enrollees via SEPs and so forth).

UPDATE: Oh for heaven's sake. Turns out HHS is projecting 13.8 million...but no one will ever believe that my own expectations were around the same range because they announced it half an hour ago and I didn't notice.

Due to an ongoing external committment, I'm not able to write up a full analysis of this, but CMS has issued their "Mid-Year Effectuation Report" which updates at least some of the ACA exchange stats for the first half of 2016:

October 19, 2016

First Half of 2016 Effectuated Enrollment Snapshot

For the first half of 2016, an average of 10.4 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals, paid their premiums and had an active policy through one of the Health Insurance Marketplaces nationwide as of that date. [i] Effectuated enrollment is generally lower in January and February, since coverage purchased in the weeks before the final Open Enrollment deadline does not begin until March. June effectuated enrollment was slightly higher than the average for the first half of the year, about 10.5 million. These amounts do not include individuals enrolled in coverage through New York and Minnesota’s Basic Health Programs, which currently enroll about 650,000 people.

The ACA exchange in Arizona has hadsome prettydramaticturns over the past month or so. When the dust settled, every county in the state will still have at least one carrier offering plans on the exchange...although only one. Anyway, today the AZ DOI joined Pennsylvania and Michigan in releasing their final approved rate hikes for both the individual and small group markets:

Right on top of Pennsylvania, the Michigan Dept. of Insurance has issued their final approvals for 2017 individual and small group market rate increases. As has been pretty typical this year, the final approved rates aren't all that different from what was requested; a little nip/tuck here and there, and the 17.2% average requested has been slightly trimmed to 16.7% approved for the indy market. Meanwhile, the small group average is barely noticeable: 2.6% requested, 2.5% approved. Unlike most states, the MI DOI has already done most of the heavy lifting for me, so I don't even have to use my own spreadsheet to calculate the weighted average.

The state Dept. of Insurance has released their approved rate hikes for 2017, and it's bad news in two different ways. First, the overall full-price average rate increase looks like it'll be roughly 32.5%...over 8 points higher than the original rates requested by the carriers. Secondly, even with those higher increases, two more indy market carriers (Keystone Health Plan and Geisinger Quality Options) are pulling off the exchange, although both will continue to offer off-exchange plans.

It's important to be careful with the full carrier names here, because they often operate under several different very similar ones (Keystone Health Plans vs. Keystone Health Plan East, for instance, which is not pulling off the exchange).

First off, let me say that I appreciate the work that you're doing here on the ACA Individual Market premium numbers. The data you provide is both comprehensive and useful, as well as possibly unique; I haven't come across another consistently-updated source for state-by-state premium figures.

I work as a Research Assistant for the Joint Economic Committee. Our committee is charged with keeping members of Congress up-to-date on the latest economic data. As you might expect, our members are keenly interested in information about the premium changes that their constituents can expect in the 2017 open enrollment period, and the JEC had hoped to cite back to your state-by-state premium increase data. Would you have any issues if we did so?

When I originally calculated the average requested rate hike for New Hampshire, I came up with a weighted estimate of around 13.1%. A month later, the average dropped a few points...but not for a good reason: One of the remaining ACA-created Co-Ops, Community Health Options, decided to pull out of New Hampshire (they started out as a Maine-only operation, expaneded into nearby NH for the 2nd and 3rd year, but are pulling back to Maine-only again). Since CHO would otherwise have been requesting a more than 40% increase, them dropping out actually lowered the average increase for everyone else. This obviously illustrates a major caveat with my "average rate increase" methodology: It only applies to those who are able to renew their existing plans. The moment a carrier pulls out of parts/all of a state, or drops PPOs (while keeping HMOs), etc, I have to remove a portion of the existing enrollees from the equation completely.

For 2017, only Blue Cross Blue Shield of Alabama will participate in the exchange. In August 2016, the carrier filed rate increases for 2017 that average 36.1 percent (with a range from 20.6 percent to 38.3 percent). This was a revised rate filing, and was slightly lower than the average rate increase proposal of 39.3 percent that the carrier initially filed in June.

The Alabama Department of Insurance approved the 36.1 percent average rate increase in October 2016, and the new rates will take effect in January 2017. AL.com reports that pre-subsidy rates for Bronze plans will increase between 20 percent and 23 percent, while Silver and Gold plans will increase in price between 32 percent and 38 percent.

Blue Cross Blue Shield of North Carolina originally requested an 18.8% rate hike back in June, but after the Aetna pullout, they revised their request upwards to 24.3%. Cigna, which is expanding onto the ACA exchange next year, followed suit by bumping up their request from 7% to 15%.

I haven't seen any formal announcement from the NC Dept. of Insurance yet, but BCBSNC just posted the following blog entry announcing their 2017 rates...and it certainly looks like the 24.3% request was indeed granted as is:

Blue Cross and Blue Shield of North Carolina customers purchasing ACA plans on the individual market will see an average increase of 24.3 percent in their premiums for 2017, compared to this year’s rates. That’s higher than our original rate filing back in May (an 18.8 percent increase).

When I plugged the numbers in for Utah way back in June, I came up with a weighted average request of around 30.7%.

Louise Norris gave me a heads up that the approved rates were in for UT, and sure enough she's correct. Not a whole lot to report, however; most of the requests were approved as is, with only minor modifications; the approved average is slightly higher:

But when four carriers (Atrio, BridgeSpan, Providence, and — off-exchange — Regence) agreed in August to cover a broader service area than they had originally intended for 2017, state regulators also allowed them to further increase their premiums due to the increased risk they would be shouldering. Final approved average rate increases for Oregon’s exchange carriers are as follows:

I originally estimated the requested average rate hike for Wisconsin indy market carriers back in August. I came up with a weighted average of around 20%...but this was questionable due to my not being able to come up with the actual enrollment figures for 4 of the 15 carriers in the state (note: several of these have more than one entry for different types of plans):

A couple of days ago, the Wisconsin Insurance Dept. announced the approved rate increases. Unfortunately, the articles about it don't provide hard numbers for either the rate change or enrollment figures for each carrier either, but they did provide the overall weighted average increase, which is really what I'm trying to calculate anyway, so there you go:

This is a minor update, but with all the bad rate hike news this year, I'll take any good news I can get. A couple of weeks ago, the Arkansas Insurance Dept. approved rate hikes for the 4 carriers participating in the ACA exchange next year, including significant reductions for all of them:

In mid-August, all of the carriers that offer plans in the Arkansas exchange proposed new rate increases for 2017, all of which were lower than their initially filed rates. Rate increases were then reduced even further for QualChoice and QCA:

There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.

Fortunately (and to their credit), the GOP state legislature worked with the Independent governor to pass a new law which created a state-based reinsurance program to stave off the ugly hikes. In July, it looked as though this would result in not-fantastic-but-not-awful 10% average increase:

A major health insurer is seeking an average rate increase of about 10 percent on individual health insurance policies in Alaska, far less than what it received the last two years. Thisfollows recent steps by the state to shore up Alaska's insurance marketplace.

Premera Blue Cross Blue Shield is expected to be the only company offering individual health policies in Alaska in 2017, with Moda Health planning to leave that market. Premera received average rate increases of nearly 40 percent for 2015 and 2016.

As I'm sure some readers have noticed, I haven't posted any updates since Friday, which is highly unusual for me, especially with open enrollment rapidly approaching. I'm afraid that due to an unfortunate coincidence of timing, I have an outside personal commitment which will be eating up a lot of my time for the next 4 weeks; as a result, expect posts to be lighter than usual.

Kaiser's 25.9% request was approved as is; HMSA's 43.3% was shot down originally; they later resubmitted it at 35%, which was then approved.

You may also notice that I've started making sure to include UNSUBSIDIZED in the headlines for all of these rate hikes. This is vitally important to remember, even if it's only relevant to around 50% of individual market enrollees.

Last year, the average full-price rate hikes approved by state regulators tended to be several percentage points lower overall than the increases requested by carriers. This year, there's been very little of that; in most case so far, the regulators have pretty much authorized the premium rate increases as requested by carriers...and in many cases have approved higher increases than requested. As a result, the overall national averages approved have been pretty close to the requests (around 24-25% nationally).

While I haven't seen any press releases or news stories about it, when I looked at HealthCare.Gov's rate review database this morning, I saw that they have fianl (approved) rate increases listed for all of the Kansas listings. In most cases the requests were approved as is; in Coventry's off-exchange plans, however, are being increased more than requested, giving the following.

I should also note that according to Louise Norris, Medica is also entering the Kansas exchange for the first time, which means there's no "increase" to list since there's no current rates to compare them to.

The Commissioner recommended approval of a 32.5 % average rate increase in the individual market for Highmark Blue Cross Blue Shield of Delaware. The approved average rate increase for the small group market for Highmark’s plans is 2.74%.

Aetna Life Insurance Company received an average of 22.8 % increase in the individual market and Aetna Health Insurance Company received an average increase of 23.6 %. In the small group market, Aetna Life received an average increase of 15.2 % and Aetna Health received an average increase of 19.7 %.

Obamacare premiums will raise a staggering 76 percent on average for Oklahoma residents, and the state's top insurance regulator says the state's insurance exchange set up by the law is on "life support."

Oklahoma's Insurance Department said on Tuesday that increases in individual marketplace plans will range from 58 percent to 96 percent.

"These jaw-dropping increases make it clear that Oklahoma's exchange is on life support," said Insurance Commissioner John Doak, in a statement. "Health insurers are losing massive amounts of money. If they don't raise rates they'll go out of business. This system has been doomed from the beginning."

With less than one month until open enrollment begins, we want you to be armed with the knowledge you need to sign up or choose a new plan for 2017. You can now browse and compare prices online at MarylandHealthConnection.gov or on your phone or tablet through our new mobile app, Enroll MHC. Find the free app in the Play Store for Android or Apple’s App Store.
Here’s how to get started:

The ACA's Medical Loss Ratio rule requires insurance carriers to spend at least 80% of all individual market premiums on actual healthcare, as opposed to CEO bonuses, exotic junkets to Tahiti, marble columns in their corporate headquarters and the like. The way it works is pretty simple: If an insurance carrier ends up spending less than 80% of the premiums paid by their enrollees on actual healthcare claims in a given year, they have to pay the difference back to their customers in the form of a rebate check the following year. You can thank Senator Al Franken for this provision, and it's a good one..so good that nationally, carriers have had to return over $2.4 billion in excessive premiums to their enrollees over the past 4 years.

So, the last day or so my email inbox & Twitter feed have been filling up with references to Bill Clinton's "Crazy System!" comments regarding the Affordable Care Act. I live in Michigan, but unfortunately couldn't make his Flint speech on Monday due to it being Rosh Hashanah.

Until now, I've been assuming that the vast majority--say, 99% or so--of those 7.1 million people who are enrolled in individual plans directly thorugh the carriers must be over 400% FPL, undocumented immigrants, have some other type of legal issue preventing them from enrolling on the exchanges, etc. etc.

HOWEVER, if McKinsey's statement above is accurate, this isn't the case at all.

Why? Because if 69% of the entire individual market (including GR/TR enrollees) is eligible for subsidies, that has to mean that some percentage of off-exchange enrollees are...and not just people in transitional/grandfathered plans.

The total market is 20.2 million people.

69% of that is appx. 12.9 million people McKinsey says are eligible for APTC.

We can account for 9.4 million of those, of course; those are the 9.4 million who are receiving APTC via exchange policies.

Subtract those, and you have another 3.5 million people eligible for APTC assistance out of the 9.1 million total off-exchange enrollees (ACA, GR & TR).

Evergreen Health, Maryland’s version of the innovative nonprofit insurers created under the Affordable Care Act, decided Monday to become a for-profit company to avoid the possibility of a shutdown, according to its chief executive.

If the switch is approved as expected by federal and state officials, Evergreen’s unprecedented move will leave standing only five of the 23 co-ops, or Consumer Operated and Oriented Plans, which started nearly three years ago.

...Evergreen, which covers nearly 38,000 Marylanders, has been trying for the past year to forge an arrangement with federal health officials to stabilize its finances. It enlisted help from the state’s congressional delegation and in June filed suit against the federal government.

As noted below, only around 8,000 are on enrolled in individual ACA exchange policies; the rest are either off-exchange or small/large group coverage.

FRANKFORT (AP) — Baptist Health Plan says it will not sell policies in Kentucky next year, meaning about 7,000 people will have to find a new insurance provider.

Kentucky’s fourth-largest insurer notified state officials in a letter. In a news release, state officials say company President James S. Fritz said Baptist Health Plan had enrolled more people than it planned and said federal risk assessments imposed by the federal Affordable Care Act are “unsustainable.”

The company’s insurance plans sold on the state’s health exchange will be good through Dec. 31. Plans sold off the exchange will expire March 31, 2017.

The news means next year people in 59 counties will have one insurance provider selling plans on the state health exchange. Off the exchange, most counties will have two options, state officials said.

BOISE, Idaho – Starting today, Idahoans can get a preview on YourHealthIdaho.org of the 225 different health and dental insurance plans being offered on the exchange in 2017.

“Before open enrollment begins on November 1, Idahoans can preview and compare different health and dental insurance plans to figure out which one best meets their needs,” said Pat Kelly, executive director of Your Health Idaho. “There are not only more plans being offered this year than ever before, but customers can see the size of the plan’s network to get a full perspective on the choices available to them.”

Prior to the 2017 open enrollment period, health insurance carriers will reach out to their customers to inform them of any changes to their current plan, including differences in rates and deductibles.